Minimally invasive parathyroidectomy

Efforts to minimize the incision, extent of exploration, length of hospital stay, and cost associated with parathyroidectomy have resulted in the development of a number of new surgical techniques, including minimally invasive, "concise," radio-guided, and endoscopic parathyroid exploration. With minimally invasive parathyroidectomy, a small incision is used in combination with a cervical block and sedation to perform a unilateral neck exploration. In so doing, risks of bilateral neck exploration are avoided, and the procedure can be done on an outpatient basis. This minimally invasive strategy has been shown to maintain the outstanding success of conventional bilateral neck exploration. All of the new surgical techniques necessitate pre-operative localization, which allows for unilateral neck exploration, and are facilitated by use of the intra-operative parathyroid hormone assay, which provides surgeons with feedback in the operating room regarding whether the patient has undergone adequate resection. (C) 2003 Elsevier Ltd. All rights reserved.